Association between the utilization of senior centers and participation in health check-ups

The global older adult population is increasing. Early detection and intervention through health check-ups are crucial for successful aging, as they play a significant role in identifying and addressing diseases. This study explored the relationship between the utilization of senior centers and the promotion of health check-ups. It utilized data from 10,097 individuals aged 65 years and above, sourced from the 2020 Elderly Survey in South Korea. The primary variable of interest was classified into two groups: those who utilized senior centers and those who did not. Subgroups were further categorized based on the frequency of usage and the presence of family members among senior centers users. Logistic regression analyses were conducted to assess the association between the utilization of senior centers and participation in health check-ups. Both men and women utilizing senior centers demonstrated a higher likelihood of participating in health check-ups compared with those who did not use senior centers. Participants visiting senior centers in a week exhibited a progressively higher likelihood of engaging in health check-ups compared with those who visited such senior centers zero times a week. Senior centers can serve as effective intervention methods to enhance health check-ups among older adults. Furthermore, this can contribute to fostering successful aging among older adults.


Variables
The dependent variable, participation in health check-ups, was categorized according to responses to two questions: "Have you undergone any health check-ups, excluding dementia screenings, in the past two years?" and "Have you undergone dementia screenings in the past two years?"Participants responding "yes" to both questions were categorized as having participated in health check-ups, whereas those participating in only one of the health check-ups or not participating in both were classified as non-participants.Health check-ups refer to general health check-ups and other health check-ups conducted by government agencies 36 .General health check-ups aim to identify manageable conditions such as hypertension, diabetes, depression, and hepatitis through early detection 37 .Dementia screenings are conducted targeting individuals aged 60 and above to detect cognitive impairment early.Screenings can be scheduled at public health centers or designated hospitals affiliated with the government at the individual's preferred time 38 .
The primary variable of interest in this study, the utilization of senior centers, was assessed by asking individuals whether they had utilized senior centers in the past year.Senior centers include local centers, elderly welfare centers, social welfare centers, women's support centers, senior citizen classrooms, public leisure, and cultural facilities.These centers refer to facilities operated by both public and private entities targeting the elderly.Various programs such as education, hobbies, social activities, and meal services are conducted in these centers.Participants' responses were recorded as "yes" or "no." Additionally, participants who reported utilizing senior centers were classified into three subgroups based on the frequency of utilization (more than five times a week, 3-4 times a week, 1-2 times a week) and family composition (living with family, living alone).
We considered sociodemographic, physical, and mental health-related factors as potential confounding variables and controlled for them.Sociodemographic factors comprised sex, education level (≤ middle school, high school, ≥ college), income (low, middle, high), Job status (yes, no), and family interaction (low, middle, high).Family interaction was categorized based on the frequency of meeting family members, such as children and relatives, into high, middle, and low categories.The family interaction variable was classified as high if there was frequency of meeting on a weekly basis, moderate if it occurred every 1-3 months, and low if it occurred on a yearly basis.Physical and mental health-related factors encompassed nutritional status (low, middle, high), alcohol status (yes, no), smoking status (yes, no), physical function (yes, no), physical activity (yes, no), subjective health status (low, middle, high), and depression (normal, moderate, severe).The subjective health status was assessed by asking participants how they perceived their own health status.Responses were categorized as very www.nature.com/scientificreports/healthy, healthy (high), average (moderate), poor, or very poor (low).Nutritional status was assessed utilizing the tool developed by the nutrition screening initiative, while depression was measured utilizing a shortened version of the geriatric depression scale.Physical function (yes, no) was evaluated utilizing activities of daily living (ADL) and instrumental ADL.

Statistical Analysis
To compare differences in participants' general characteristics, chi-square tests were conducted, and the results were presented in frequencies and percentages.To explore the association between the utilization of senior centers and participation in health check-ups, logistic regression analysis was performed.Furthermore, the frequency of senior center utilization (five times or more per week, 3-4 times, 1-2 times, zero times) and the family composition of senior center users (living with family, living alone) were each subdivided into subgroups.The logistic regression analysis, indicated with a 95% confidence interval (CI) and odds ratio (OR), was conducted utilizing SAS version 9.4.Statistical significance for all analyses was set at a p-value of less than 0.05.

Results
Table 1 presents the differences in the general characteristics of the population stratified by gender.The participation rate in health check-ups was 39.4% (N = 1590) for male participants and 42.2% (N = 2561) for female participants, indicating that women were more inclined to participate in health check-ups than men.The likelihood of participation increased with age, lower nutritional status, non-alcohol consumption, physical impairment, lack of physical activity, and self-perceived poor health.
Table 2 presents the outcomes of the logistic regression analysis examining the correlation between the utilization of senior centers and participation in health check-ups.Among individuals utilizing senior centers, men and women were 1.69 and 1.23 times more likely to participate in health check-ups, respectively, compared with individuals who did not use utilize senior centers (men: adjusted OR: 1.69; 95% confidence interval, 1.46-1.97p-value: < 0.0001; women: aOR, 1.23; 95% CI 1.10-1.39,p-value: 0.0002).Additionally, individuals with good physical function had lower odds of undergoing health check-up compared to those with poor physical function.(men: aOR: 0.70; 95% CI 0.53-0.94,p-value: 0.0169; women: aOR, 0.71; 95% CI 0.58-0.89,p-value: 0.0023).
Table 3 presents the subgroup analysis of health check-up participation according to the utilization of senior centers.Among women with severe depression, those utilizing senior centers were 1.59 times more likely to participate in health check-ups compared with those who did not utilize these centers (aOR, 1.59; 95% CI 1.03-2.46,p-value: < 0.0001).
Additionally, subgroup analyses stratified by senior center utilization frequency and user's family composition were conducted.As exhibited in Table 4, both sexes display a progressively increasing likelihood of participating in health check-ups as the frequency of utilizing senior centers per week rises.Male and female participants who utilized senior centers 1-2 times per week had 1.55-fold (95% CI 1.28-1.90)and 1.29-fold (95% CI 1.11-1.50,)higher odds, respectively, of participating in health check-ups compared with those who did not utilize these senior centers.Male and female participants utilizing the senior center 3-4 times had 1.64-fold (95% CI 1.34-2.02,)and 1.29-fold (95% CI 1.11-1.50higher odds, respectively, and those using them five times or more had 2.47fold (95% CI 1.97-3.12)and 1.84-fold (95% CI 1.59-2.15)higher odds, respectively, compared with those not utilizing senior centers.
The analysis was conducted by classifying individuals who use the senior citizen center based on whether they live with their families.Compared to those who do not use the senior citizen center, it was found that elderly individuals living alone are more likely to receive health check-ups when utilizing the senior citizen center (men: aOR, 2.11; 95% CI 1.63-2.73;women: aOR, 1.52; 95% CI 1.34-1.73).All p-values for the subgroup analysis were < 0.0001.

Discussion
This study identified an association between the utilization of senior centers and participation in health checkups.Individuals utilizing senior centers exhibited a higher inclination of participating in health check-ups compared with those who did not utilize these facilities.This finding, controlling for family interaction, suggests that interactions among peers excluding family members, might influence participation in health check-ups among older adults.Moreover, there was a progressive increase in the likelihood of participating in health check-ups as the frequency of utilizing senior centers increased.Among users of senior centers, individuals living alone exhibited a higher likelihood of participating in health check-ups.This underscores the potential association between social relationships and participation in health check-ups.
It well-established that social relationships play various positive roles in the lives of older adults, encompassing health and more 39 .Previous studies have emphasized the significant role of social networks in promoting various health-related behaviors and facilitating health check-ups 40,41 .Other research has demonstrated that older adults with close family relationships and active engagement in social activities are more likely to undergo regular health check-ups 42,43 .The greater the social support from family, friends, and others, the stronger the association with participation in health check-ups 44 .Furthermore, it has been noted that this association extends not only to health check-ups but also to preventive health behaviors such as vaccinations 23 .Previous studies have indicated the association between social support and participation in health check-ups for both men and women 31 .This association was also found to be significant for both genders in the current study.Additionally, it demonstrated that participants engaging in social activities, such as utilizing senior centers, were more likely to participate in health check-ups than those who did not.However, unlike previous studies, this research focused on interactions with peers through the utilization of senior centers, controlling for interactions with family and relatives.Moreover, the analysis of the relationship between usage frequency and participation in health www.nature.com/scientificreports/check-ups indicated a correlation between increased social activity and a higher likelihood of participating in health check-ups.www.nature.com/scientificreports/According to Andersen's healthcare utilization model, healthcare utilization is influenced by four elements: environmental, demographic characteristics, health behavior, and health outcomes 22 .From a psychological perspective, social isolation in old age is considered a potential obstacle to participation in health programs 21,45 .Socially isolated individuals often place lower value on health compared with their non-isolated counterparts 24 .www.nature.com/scientificreports/This diminished valuation of health acts as a deterrent to engaging in health management behaviors 24 .Socialization and social support serve as motivational factors for older adults to consistently engage in health behaviors 25 .
Previous research has highlighted that, while individuals recognize the importance of improving health through health behaviors, they might naturally engage in health-promoting activities as part of their involvement in social activities 25 .Among older adults, self-efficacy promotes health-seeking behaviors and becomes a predictive concept for actions such as health check-ups 46 .Older adults with higher self-efficacy are more likely to utilize preventive medical care and undergo health check-ups compared with those with lower self-efficacy 47 .Additionally, friendship interactions among older adults exhibit a positive correlation with self-efficacy 48 .This study has several limitations.First, it is a cross-sectional study, which hinders the determination of causality between factors, making it challenging to evaluate the sequence of events leading to outcomes.Second, the reliance on self-reported survey methods might compromise the reliability of the results.Third, despite attempts to control for covariates that may influence the dependent variable, uncontrolled confounding variables might have impacted the results.Fourth, variables related to hospitalization or long-term care admission could not be controlled for, which may have influenced the results.
However, this study also possesses several strengths.First, the data utilized in the study targeted the national population, enhancing its representativeness.Second, conducting face-to-face interviews by trained professionals could enhance the reliability and validity of survey responses.

Conclusion
The results of this study suggest a potential association between the use of community centers by the elderly and participation in health screenings.With the global population aging, the efficient management of older adult health has become a critical area of interest.This study suggests the possibility that facilities where the elderly gather could be utilized for health management purposes. https://doi.org/10.1038/s41598-024-61995-3

Table 1 .
General characteristics of the study population by gender.

Table 2 .
Results of logistic regression analysis investigating the association between senior center utilization and participation in health check-up.Significant values are given in bold.aOR adjusted odds ratio, CI confidence interval.

Table 3 .
Subgroup analysis of health check-up participation according to the use of elderly facilities.aOR adjusted odds ratio, CI confidence interval.

Table 4 .
Results of subgroup analysis stratified by frequency of use of facilities for the elderly and family composition of users.aOR adjusted odds ratio, CI confidence interval.